jMedical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom

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Abstract

Patients on long-term hemodialysis are at very high risk for cardiovascular disease but are usually excluded from clinical trials conducted in the general population or in at-risk populations. There are no universally agreed cardiovascular outcomes for trials conducted specifically in the hemodialysis population. In this review, we highlight that trials reporting cardiovascular outcomes in hemodialysis patients are usually of short duration (median 3 to 6 months) and are small (59% of trials have <100 participants). Overall, the cardiovascular outcomes are very heterogeneous and may not reflect outcomes that are meaningful to patients and clinicians in supporting decision making, as they are often surrogates of uncertain clinical importance. Composite outcomes used in different trials rarely share the same components. In a field in which a single trial is often insufficiently powered to fully assess the clinical and economic impact of interventions, differences in outcome reporting across trials make the task of meta-analysis and interpretation of all the available evidence challenging. Core outcome sets are now being established across many specialties in health care to prevent these problems. Through the global Standardized Outcomes in Nephrology–Hemodialysis initiative, cardiovascular disease was identified as a critically important core domain to be reported in all trials in hemodialysis. Informed by the current state of reporting of cardiovascular outcomes, a core outcome measure for cardiovascular disease is currently being established with involvement of patients, caregivers, and health professionals. Consistent reporting of cardiovascular outcomes that are critically important to hemodialysis patients and clinicians will strengthen the evidence base to inform care in this very high-risk population.

Footnotes

This project is supported by a National Health and Medical Research Council (NHMRC) program grant (1092597) and project grant (1098815). Dr. Viecelli has received grant support from the NHMRC Medical Postgraduate Scholarship (1114539) and the Royal Australasian College of Physicians (Jacquot NHMRC Award for Excellence). Dr. O’Lone has received support from the NHMRC Medical Postgraduate Scholarship (1114189). Dr. Herrington is supported by a Medical Research Council-Kidney Research UK Professor David Kerr Clinician Scientist Award. Dr. Tong is supported by an NHMRC Research Fellowship (1106716). Dr. Wang has received an honorarium and grant support from Sanofi Renal. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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